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Paramedic Care:
Principles & Practice
Volume 5
Trauma Emergencies
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Chapter 2
Blunt Trauma
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Introduction to Blunt Trauma Blunt trauma is the most common cause of trauma-
related death and disability.
True nature of the injury is often hidden.
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Physics 101
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Kinetics Kinetics is a branch of physics dealing with objects in
motion and the energy exchanges that occur as objects
collide.
Deals with motion and energy exchanges
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Kinetics of Impact Two basic principles of kinetics:
Laws of inertia
Energy conservation
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Law of Inertia Newton’s first law:
“A body in motion will remain in motion unless acted upon
by an outside force.”
“A body at rest will remain at rest unless acted upon by an
outside force.”
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Energy Conservation Law of Energy Conservation
“Energy can neither be created nor destroyed. It can only
be changed from one form to another.”
All the energy of motion converts to other energy forms.
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Types of Energy Potential
Kinetic
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Kinetic Energy Kinetic energy of an object while in motion is
measured by the following formula:
KE = mass (weight) x velocity (speed)2
2
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Kinetic Energy When you double an object’s weight, you double its
kinetic energy.
As speed (velocity) increases, there is a larger
(squared) increase in kinetic energy.
Releasing energy slowly, as occurs with braking,
results in a tolerable transfer of energy while stopping.
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Force Newton’s second law of motion explains the forces at
work during a collision:
Force = Mass (Weight) X Acceleration (or Deceleration)
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Force The formula emphasizes the importance of the rate at
which an object changes speed.
Gradual changes in speed are usually uneventful.
When significant kinetic energy is applied to human
anatomy, we call it trauma.
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Biomechanics of Trauma
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Biomechanics of Trauma Describes the actual injury process.
Bound by the laws of physics:
Inertia, energy conservation, and force
Trauma is divided into two general categories:
Blunt
Penetrating
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Blunt Trauma The Force enters the
body, not the object.
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What Causes the Injury? Compression (opposite of stretching)
Stretching (opposite of compression)
Shearing
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Skin Resistant to compression and stretching (hides injuries)
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Bone Very strong but will fx with shearing forces
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Lung Compression is bad
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Hollow Organs Tolerant unless filled with fluid or air
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Biomechanics of Trauma
Blunt
Closed injury
Indirect injury to
underlying structures
Transmission of energy
into the body
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Biomechanics of Trauma
Penetrating
Open injury
Direct injury to
underlying structures
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Automobile Collisions 44,000 people die each year on U.S. highways.
Events of Impact:
Vehicle collision
Body collision
Organ collision
Secondary collisions
Additional injuries
Vehicle receives a second impact
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Automobile Collisions
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Automobile Collisions
Restraints
Seatbelts
Airbags (SRS)
Reduce blunt chest
trauma
Cause: hand, forearm,
and facial injury
Check for steering
wheel deformity
Side airbags
Child Safety Seats
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Automobile Collisions Types of Impact
Frontal
Lateral
Rotational
Rear-end
Rollover
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Frontal Impact Up-and-Over
Tenses legs = bilateral femur fracture
Hollow organ rupture and liver laceration
Similar chest trauma
Axial loading
Down-and-Under
Knee, femur, and hip fracture
Chest trauma – steering wheel
Paper bag syndrome
Ejection
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Lateral Impact
15% of MVCs but 22% of
deaths
Upper extremity injury
Rib, clavicle, humerus,
pelvis, femur fracture
Lateral compression
Ruptured diaphragm
Spleen fracture
Aortic injury
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Rotational Impact
Vehicle struck at oblique
angle
Less serious injuries
unless strike a
secondary object
© Mark C. Ide
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Rear-End Collisions
Rear-end
Seat propels the occupant
forward
Head is forced backward
Stretching of neck muscles and
ligaments
Hyperextension and
hyperflexion
© Mark C. Ide
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Rollover
Rollover
Multiple points of impact
Ejection or partial ejection
Less injury with restraints
© Mark C. Ide
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What kind of car do you see?
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Vehicle Collision Analysis Hazards
Crumple zones
Intrusion
Deformity of vehicle
Use of restraints Undeployed airbags should be deactivated by trained
fire/extrication personnel
Intoxication Fatal collisions: >50% involve legal intoxication
Recreational accidents
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Automobile Collision
Evaluation
© Ray Kemp/911 Imaging
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Automobile Collisions Vehicular Mortality
Head: 48%
Internal (torso): 37%
Spinal and chest fracture: 8%
Extremity fracture: 2%
All other: 5%
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Automobile Collision
Evaluation
Collision Questions
How did collision occur?
Direction?
Speed?
Similar/different sized?
Secondary collisions?
Cause of Collision
Weather and visibility?
Alcohol involved?
Skid marks?
Auto Interior
Starring of windshield?
Steering wheel deformity?
Dash deformity?
Intrusion?
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Motorcycle Collisions Serious injuries can occur with high- and low-speed
collision
Types of Impact
Frontal
Angular
Sliding
Ejection
Initial bike/object collision
Rider/object
Rider/ground
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Pedestrian Collisions
Adults
Adults turn away
Bumper strikes lower
legs first
Victim rolls up and over
and thrown
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Pedestrian Collisions
Children
Children turn toward
Femurs, pelvis often
injured
Thrown away or run
over
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Recreational Vehicle
Collisions Lack structure and restraint system
Types of Vehicles
Snowmobiles
Personal watercraft
ATVs
Often see injuries in children due to lack of skills and training
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Blast Injuries
Explosion
Pressure Wave
Blast Wind
Victim Displacement
© Joshua Menzies
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Blast Injuries
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Explosion Pressure Wave
Structural collapse
Blast wind
Burns
Projectiles
Terrorist devices may contain nails, screws, or other
materials meant to cause additional injury and
destruction.
Personnel Displacement
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Explosion Blast Injury Phases
Primary: Heat of the explosion
Secondary: Trauma caused by projectiles
Tertiary: Personnel displacement and structural collapse
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Explosion Blast Injury Assessment
Be alert for secondary device
Initial scene size-up important
Establish Incident Command System (ICS)
Evaluate for secondary hazards
Injury Patterns:
Rupture of air- or fluid-filled organs
Lung: Late manifestation (heat and pressure)
Hearing loss
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Explosion Lungs
Forceful compression and distortion of chest cavity
Compression and decompression
Pulmonary embolism, dyspnea, hemoptysis, pneumothorax
Abdomen
Compression and decompression
Release of bowel contents
Diaphragm rupture from pushing of organs up into thorax area
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Explosion Ears
Initial hearing loss
Injury improves over time
Penetrating Wounds
Care as any serious open wound or impaled object
Burns
Treatment consistent with traditional management
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Other Types of Blunt Trauma Falls
The initial impact may involve other body surfaces with the forces of deceleration
Evaluating a fall
Determine the point of impact
The fall height
The impact surface
The transmission pathway of forces along the skeleton
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Other Types of Blunt Trauma Sports Injuries
Sports injuries are most commonly produced by extreme
exertion, fatigue, or by direct trauma forces.
Injuries can be secondary to acceleration, deceleration,
compression, rotation, hyperextension, or hyperflexion.
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Other Types of Blunt Trauma Crush Injury
Cause
Structural collapse, explosion, MVC, industrial, or agricultural
Great force to soft tissue and bones
Tissue stretching and compression
Extended pressure results in anaerobic metabolism distal to
compression
Return of blood flow, toxins to entire body
Severe hemorrhage due to severe damaged blood vessels
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Questions?